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Introduction: Using an ambulance as an attack modality offers many advantages to a terrorist organization. Ambulances can carry more explosives than most vehicles and can often bypass security. Yet, studies examining how terrorist organizations have incorporated ambulances into their attacks are lacking.Study Objective: This article seeks to identify and analyze known instances in which an ambulance has been used in a terrorist attack.Methods: The Global Terrorism Database (GTD) was searched for terrorist events that involved the use of an ambulance from the years 1970-2018. Variables of event time, location, and loss of life were analyzed.Results: Twenty instances where an ambulance had been used in a terrorist attack were identified from the GTD. Fifteen of the attacks occurred in the Middle East, while the remaining five occurred in Southeast Asia. All attacks except one had occurred after 2001, and 13 had occurred within the past decade. Most attacks (12/20) resulted in up to three people killed, while six attacks had 10-20 casualties. The deadliest attack occurred in Kabul, Afghanistan in 2018 and caused over 100 casualties. One event did not have casualty information in the GTD. In all cases, ambulances were used as vehicle-borne improvised explosive devices (VBIED) by terrorist organizations.Conclusion: This study shows that terrorists are increasingly acquiring and utilizing ambulances in their attacks, often with deadly consequences. Security and public health experts must be aware of this hazard and work to deny terrorists access to these vehicles. [ABSTRACT FROM AUTHOR]

During periods of civil unrest, emergency medical services (EMSs) clinicians will be called upon to provide care to those impacted, including those who are actively instigating violence. Working during periods of civil unrest poses significant operational and security challenges to EMS leadership and clinicians. This review provides best practices for EMS operating during periods of civil unrest through analysis of after action reports from Baltimore, Maryland; Charlottesville, North Carolina; Minneapolis, Minnesota; and Washington, DC.

Background: Shooting events in hospitals are increasing in frequency, with the emergency department (ED) being the most common site of such events. EDs must be prepared for shooting events, but current practices surrounding active shooter preparation are unknown., Objective: To determine what active shooter training emergency medicine physicians are receiving., Methods: A survey was developed to assess current practices around active shooter preparation in EDs. The survey was distributed to members of the American College of Emergency Physicians' Emergency Medicine Practice Research Network. All members of the Emergency Medicine Practice Research Network are currently practicing emergency medicine physicians., Results: There were 194 respondents. The most common form of training received was online (76/194), followed by lecture (50/194). Only 39 respondents had participated in an active shooter drill. Sixty-five respondents (33 percent) reported having never received any formal active shooter training., Conclusion: There is a wide array of active shooter training that emergency medicine physicians are receiving, with nearly one-third receiving no training at all.

Introduction and Objectives: Emergency medical services (EMS) is an invaluable healthcare resource, providing life-saving care in the prehospital setting. During the COVID-19 pandemic, there have been concerns that healthcare resources, including EMS, would be overwhelmed by the potential surge in critically ill patients. This study seeks to determine the impact of the COVID-19 pandemic on EMS utilization in the state of Maryland., Methods: A retrospective review of data from the Maryland Emergency Medical Services Data System was performed. EMS call volumes were compared from March 1 to August 31 in the years 2018, 2019, and 2020. In addition, adult cases from the three time periods that contained an EMS impression of stroke, cardiac arrest, asthma, traumatic injury, ST elevation myocardial infarction (STEMI), sepsis, and overdose were also analyzed., Results: There was a significant decrease in overall EMS call volumes in the state of Maryland in the first 6 months of 2020 compared to the prior 2 years. While the total number of calls decreased, a higher proportion of patients in 2020 had EMS impressions of cardiac arrest, STEMI, stroke, and traumatic injury compared to the previous 2 years. Additionally, there was an increase in termination of resuscitation for out of hospital cardiac arrest., Conclusion: In the state of Maryland, overall call volumes decreased, but the proportion of EMS patients with time-sensitive illnesses increased during the COVID-19 pandemic.